A Transition Dilemma: One Hospital’s Effort to Improve Post-Treatment Quality of Life

Dr. Lara Traeger remembers the exact circumstances of what led to her research.

An early-stage lung cancer patient undergoing treatment expressed anxiety and stress regarding the future. He was a marathon runner, one of his life passions, and he had concerns about whether that passion was in the past.

Would he be able to run a marathon again? What about living the active lifestyle he once enjoyed? Would he struggle just to breathe?

“He experienced a lot of stress and anxiety due to what the future might hold,” said Dr. Traeger, a clinical psychologist at Massachusetts General Hospital.

He also didn’t have anyone on hand to help calm his nerves. For months, this patient had a team of medical experts offering support. He had oncologists, nurses and many others by his side.

When treatment ended, though, he was largely on his own, with all those questions about the future and worries about whether he’d live a happy and fulfilling life.

People who go through treatment for mesothelioma face the same mental challenge. Months of chemotherapy and radiation — or post-surgery rehabilitation — suddenly stops, paving the way for independence.

That’s a scary switch. As Dr. Traeger explains, it’s “kind of like falling off a cliff of support.”

So the oncologist recommended the patient speak with a staff psychologist. That psychologist realized the hospital could explicitly use this patient’s experience to create a mental health program for new mesothelioma (and lung cancer) survivors.

The Transitions Program is now in a trial period to tap into the benefit of post-treatment counseling sessions. The hope is to improve patients’ expectations — and quality of life — as they enter a post-treatment and post-cancer life.

 

Inspiration for the Program

The researchers and psychologists running the study talked with patients going through mesothelioma treatment and those who completed their therapy regimen. They noticed recurring concerns.

“People who were done with treatment said they were having a lot of struggles they didn’t expect to have,” Dr. Traeger said in an exclusive interview with Mesothelioma Guide.

“One patient said, ‘It actually got harder for me. I didn’t have a concrete plan.’”

This response, in a nutshell, explains the need to analyze this concept among more patients. Dr. Traeger and her team designed their study with a few key steps in mind:

• First, ask survivors what their hopes, wishes and goals were as they finished treatment.
• After about a month, revisit those goals and ask if they met them.

The answer was a consistent “no.” Marathon runners had shortness of breath due to treatment. Full-time workers didn’t have the strength or energy to handle a 40-hour-a-week schedule right away.

Attaining goals is vital to a high quality of life, Dr. Traeger said. Regular therapy sessions would help patients reflect on why a particular goal is important to them.

“We then show how to use that information to revise the goal when needed but still make sure that the goal is important or meaningful to them,” Dr. Traeger said.

 

Treating a Fear of Recurrence

Dr. Traeger explained that several studies are looking at how to improve the quality of life for people affected by various types of cancer: brain, ovarian, throat, breast and more. A lot of these diseases have low rates of recurrence, but survivors still fear their cancer returning.

The mental health trick for patients is easy: Remind them that their chances of recurrence are low. That tactic doesn’t apply to mesothelioma, which has a high rate of recurrence.

“In comparison, when you’re dealing with a cancer that could possibly return, there’s a kernel of truth to that (fear),” she said. “You can’t use the traditional psychology that we normally would use to challenge these fears.”

What should mesothelioma survivors expect their life to be like? Will their relationships change? Will they be able to return to work or an active lifestyle?

How will they handle their neverending shortness of breath following their lung-removal surgery for pleural mesothelioma?

And should they be anxious whenever a doctor walks in with the results of their one-year check-up scan?

“Will the symptoms go away? Are the scans going to be clear? What does my future hold? What does my family’s future hold?” Dr. Traeger noted as questions patients regularly worry about.

“Practical strategies to deal with uncertainties is what we do in the program.”

 

How the Study Works

Massachusetts General Hospital’s Transitions Program study compares two groups of patients. One will undergo a counseling session right when their treatment ends, and then one 14 weeks later.

The second group will get the same, along with regular therapy sessions during those 14 weeks.

“Our primary outcome is quality of life,” Dr. Traeger explained. “Our target, which we’re trying to change, is people’s ability to cope with uncertainty, cope with symptoms, and satisfaction with relationships.”

The one-on-one sessions occur with a staff psychologist or psychology trainee (under supervision) with Massachusetts General Hospital. They can be in-person sessions or virtual (via video conference or phone) as a safety precaution during the COVID-19 coronavirus pandemic.

Two of the most important questions for the patients who undergo regular therapy sessions are:

• How has the program impacted you?
• What is and what is not helpful?

The hope is that by the end of the study, Dr. Traeger and her colleagues have evidence to support a full-fledged program, or at least continue the trial period with a larger number of patients.

“We will take this information and do a larger study where we can answer those questions,” Dr. Traeger said.